The treatment of the open tibial fractures is still an orthopaedic challenge and full of complications. In many cases the use of external fixation that has been known as a non-union machine is obligatory with a high incidence of pin track infection and other complications. The aim of this study was to compare the use of external fixation as a definite method of treatment of open tibial fractures with it’s subsequent conversion to internal fixation or casting.

During June 2004 to July 2006 in a randomized controlled trial 67 patients with types A and B of Arbeitsge-meinschaft fur Osteosynthesefragen (AO) open type III Gustilo tibial and fibular diaphyseal fractures were studied. Mean age of the patients was 25 years (18–40 years) and mean follow up time was 8 months.

After the external fixation of the fractures, the patients were divided into three groups by drawing from the random table of numbers. Group one consisted of 20 patients were selected for delayed conversion to internal fixation after 6–8 weeks (after three weeks of removal of external fixator).

Group two consisted of 25 patients in whom external fixation had continued in order to convert to Patellar Tendon Bearing (PTB) cast after developing union.

The remaining 22 patients were considered as group three in whom external fixation was continued until complete union.

There was a meaningful difference only in the union time (P=0.001) and superficial infection (P=0.018) between the first group and the other two groups.

So, in the treatment of the open tibial fractures there is priority for method of conversion of the external fixation to internal fixation compared to the other protocols of treatment.

Extensor tondon lacerations are much more common than flexor tendon injuries. The outcome of this lesions depends on mamy factors including severity of initial trauma, coexisting lesions, of the hand, site of the laceration, experience of the surgeon, and post operative rehabilitation. The aim of this prospective study was to review our results of primary extensor tendon repair with regard to the zone of injury.

During a period of 28 months, 32 patients with open extensor tendon laccerations were repaired by modified kessler technique using 4-0 nonabsorbable suture. After tendon repair, immobilization with a volar splint was applied for 4-weeks and physiotherapy was carried out. Patients were followed–up for a mean of 12 months. we used the 5 extensor tendon zones and results were assesed using Miller’s rating system. Patents with closed tendon ruptures or concomitant hand fracture were excluded from the study.

Seventy two extensor tendons were repaired. The mean age of patients was 24.6 years (17–46 y). Excellent and good resalts were obtained as the follows: in zone 5(88/4%), zone 3 (84%), zone 2(55.5%), zone 4(42.7%), zone 1(40%). Results were poor in zone 4(42.8%), zone 1(40%), zone 2(22.2%), zone 3(4%), and zone 5(3.9%). No in fection was seen.

We found a strong correlation between the site of the repair and outcome. More excellent and good results were obtained when the repair was performed distal to the extensor retinaculum (Zone 3), and above the wrist (Zone 5). Unsatisfactory results were seen when the tendon repair was done at or near DIP joint (zone 1), in the region of complex extensor mechanism (zone 2) or beneth the extensor retinaculum (zone 4). We cocluded the anatomic location of tendon repair has an important effect in outcome.